Page 83 - International guidelines for groin hernia management

Hernia

of 28 who had temporary pain reduction following nerve term pain reduction with gabapentin. 237 However, the
block. Overall, this approach led to pain reduction in 24 of general pain literature on neuropathic pain (NeuPSIG
28 (83%) patients. 235 guideline, http://www.neupsig.org/) does provide a step-
wise treatment scheme. 238
Discussion Limited evidence exists for the use of lidocaine and
A stepwise multidisciplinary approach starting with mini- capsaicin patches in CPIP patients. One crossover trial of
mally invasive measures like analgesics and nerve blocks is 21 patients found no benefit for lidocaine patches. 239
advocated in all studies. Neurectomy seems reasonable Another study failed to show a statistically significant
after a minimum waiting period of 6 months without an benefit of the capsaicin patch, although there was a trend
240
adequate response to other therapy. Again, a paucity of toward less pain in the capsaicin group at 1 month.
evidence in this important subject area allows only a weak
grade for the recommendation. Discussion
There is little in the medical literature on non-pharmaco-
Key question logical treatment options for CPIP. Lidocaine and capsaicin
patches have not been proven to be effective for this
KQ19T.c Does non-pharmacological treatment work in condition.
CPIP?

Evidence in literature Key question
No studies exist on non-pharmacological treatments (e.g.,
physical therapy, acupuncture, and mind–body therapy) for KQ19T.d What is the effect of non-surgical interventional
CPIP, although there are some general articles on chronic treatment on chronic pain after IH repair?
pain modification and improvement by cognitive and
emotional means. 236

Remarkably, even pharmacological treatments (e.g. Evidence in literature
NSAIDs, acetaminophen/paracetamol, TCAs, SSRIs, Limited evidence exists for the use of local nerve blocks
gabapentin, pregabalin, and opioids) of CPIP have rarely for CPIP treatment. No studies have investigated whether
been studied. Only one relevant case report describes long- nociceptive pain can be reliably distinguished from

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